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DOJ Announces Healthcare Fraud Takedown: Legal Implications for Providers, Executives, and Healthcare Business Owners

The Department of Justice (DOJ) recently announced one of the largest healthcare fraud enforcement actions in U.S. history. According to the DOJ, the nationwide operation resulted in charges against 455 defendants in connection with more than $6.5 billion in alleged fraud. This enforcement action broadly targeted physicians, nurse practitioners, executives, marketers, medical business owners, and [...]

Healthcare Fraud Defense for Hospice Providers

Hospice service providers are one of the most heavily scrutinized segments of the U.S. healthcare industry. The Office of Inspector General (OIG) of the Department of Health and Human Services has flagged hospice billing as a persistent area of concern in its annual Work Plans for well over a decade. In fiscal year 2025 alone, [...]

Civil vs. Criminal Healthcare Fraud Cases

Mishandling an accusation of healthcare fraud can cost you and your facility millions of dollars in fines and potentially result in a prison sentence. Knowing how prosecutors coordinate civil and criminal investigations can save your practice, reduce individual and corporate penalties, and help you navigate your career seamlessly through a complex legal battle.  Lowther Walker [...]

Medicare Payment Suspensions: What Healthcare Providers Need to Know in Response

Pursuant to 42 C.F.R. §405.371(a)-(c), Medicare payments to participating providers may be suspended, offset, or recouped by CMS or one of its authorized contractors This post explains the legal framework governing Medicare payment suspensions, the circumstances under which they are imposed, and the steps providers should take if they receive a suspension notice. Background: A [...]

How Does The Government Prove Intent In Healthcare Fraud?

Healthcare fraud is a specific intent crime, meaning the government cannot secure a conviction simply by proving that false claims were submitted. Prosecutors must demonstrate that the defendant knowingly and willfully acted to defraud — a standard that requires getting inside the mind of the accused. Here is how they do it. Intent Under 18 [...]

Healthcare Fraud Defenses Guide

Legal defenses for healthcare fraud charges challenge allegations of fraudulent billing for financial gain. Healthcare fraud prosecutions under statutes such as the False Claims Act, Anti-Kickback Statute, and Stark Law carry severe penalties. Providers can face prison, exclusion from Medicare and Medicaid, and the permanent loss of professional licensure. Mounting a strong defense is imperative. [...]